Claims Review Procedures. In the event a claim is denied, the reasons for the denial shall be specifically set forth in the notice described in this Section 9.18 in language calculated to be understood by the claimant. Pertinent provisions of the Plan shall be cited, and, where appropriate, an explanation as to how the claimant can request further consideration and review of the claim will be provided. In addition, the claimant shall be furnished with an explanation of the Plan's claims review procedures. Any Employee, former Employee, or Beneficiary of either, who has been denied a benefit by a decision of the Plan Administrator pursuant to Section 9.17 shall be entitled to request the Plan Administrator to give further consideration to his claim by filing with the Plan Administrator (on a form which may be obtained from the Plan Administrator) a request for a hearing. Such request, together with a written statement of the reasons why the claimant believes his claim should be allowed, shall be filed with the Plan Administrator no later than 60 days after receipt of the written notification provided for in Section 9.17. The Plan Administrator shall then conduct a hearing within the next 60 days, at which the claimant may be represented by an attorney or any other representative of his choosing and at which the claimant shall have an opportunity to submit written and oral evidence and arguments in support of his claim. At the hearing (or prior thereto upon 5 business days' written notice to the Plan Administrator), the claimant or his representative shall have an opportunity to review all documents in the possession of the Plan Administrator which are pertinent to the claim at issue and its disallowance. A final disposition of the claim shall be made by the Plan Administrator within 60 days of receipt of the appeal unless there has been an extension of 60 days and shall be communicated in writing to the claimant. Such communication shall be written in a manner calculated to be understood by the claimant and shall include specific reasons for the disposition and specific references to the pertinent Plan provisions on which the disposition is based. For all purposes under the Plan, such decision on claims (where no review is requested) and decision on review (where review is requested) shall be final, binding and conclusive on all interested persons as to participation and benefits eligibility, the amount of benefits and as to any other matter of fact or interpretation relating to the...
Claims Review Procedures. When a benefit is due, the Claimant should submit a claim to the Committee. Under normal circumstances, the Committee will make a final decision as to a claim within 90 days after receipt of the claim. If the Committee notifies the Claimant in writing during the initial 90-day period, it may extend the period up to 180 days after the initial receipt of the claim. The written notice must indicate the circumstances necessitating the extension and the anticipated date for the final decision. If a claim is denied during the claims period, the Committee must notify the Claimant in writing, and the written notice must set forth in a manner calculated to be understood by the Claimant:
Claims Review Procedures. 1. If the Claims Administrator denies a claim, the Claims Administrator shall provide a written denial notice to the Retired Participant. The notice shall be written in a manner calculated to be understood by the claimant and shall set forth (i) the specific reason(s) for the denial; (ii) specific references to the pertinent Plan or administrative provisions or procedures on which the denial is based; (iii) a description of any additional material or information necessary for the claimant to perfect the claim and an explanation as to why such information is necessary; and (iv) an explanation of the Plan’s claims procedure.
Claims Review Procedures. In the event that any benefits payable under the terms of this Executive Employment Agreement shall become subject to the Employer Retirement Income Securities Act (“ERISA”), the following claims procedure shall apply to all such benefits (but shall not apply to any benefits that are not subject to ERISA):
Claims Review Procedures. In the event a claim is denied, the reasons for the denial shall be specifically set forth in the notice described in this Section 9.18 in language calculated to be understood by the claimant. Pertinent provisions of the Plan shall be cited, and, where appropriate, an explanation as to how the claimant can request further consideration and review of the
Claims Review Procedures. Where the words Plan Administrator are used, this shall also mean Corporation's representative. After the claims adjudicator has denied or terminated an employee's claim based on an internal review, the employee must inform the claims adjudicator within days from the date claim has been denied or terminated that wishes to appeal the claims adjudicator's decision. The claims adjudicator informs the Plan Administrator of the requested appeal The Plan Administrator requests a case summary from the claims adjudicator. The Plan Administrator informs the Directors of the Society, for their information only. The Plan Administrator sends a letter to the employee with instructions for the selection of the employee's designated medical doctor. The Union shall receive a copy of any letter applicable to one of its members. The Plan Administrator appoints the Plan's designated medical doctor. The Plan Administrator receives information from the employee as to designated medical doctor.
Claims Review Procedures. For information on how to submit the initial claim of the employee, see the claim submittal procedures described in the plan program. For each one of the plan options, the plan offers a specific amount of time, as required by law, to evaluate and respond to claims for covered benefits under the Employment Retirement Income Security Act of 1974 (ERISA). The time frame the plan has to evaluate and respond to a claim begins on the date the claim is initially submitted. The process for submitting a claim for the various benefits offered under the plan can vary. If the employee has questions about how to appeal a claim, he or she should contact the plan administrator or review the health insurance agreements documentation or this certificate for the benefit in question.
Claims Review Procedures. In the event a claim is denied, the reasons for the denial shall be specifically set forth in the notice described in this Section 9.18 in language calculated to be understood by the claimant. Pertinent provisions of the Plan shall be cited, and, where appropriate, an explanation as to how the claimant can request further consideration and review of the claim will be provided. In addition, the claimant shall be furnished with an explanation of the Plan's claims review procedures. Any Employee, former Employee, or Beneficiary of either, who has been denied a benefit by a decision of the Plan Administrator pursuant to Section 9.17 shall be entitled to request the Plan Administrator to give further consideration to his claim by filing with the Plan Administrator (on a form which may be obtained from the Plan Administrator) a request for a hearing. Such request, together with a written statement of the reasons why the claimant believes his claim should be
Claims Review Procedures. In the event a claim is denied, the reasons for the denial shall be specifically set forth in the notice described in this Section 9.18 in language calculated to be understood by the claimant. Pertinent provisions of the Plan shall be cited, and, where appropriate, an explanation as to how the claimant can request further consideration and review of the claim will be provided. In addition, the claimant shall be furnished with an explanation of the Plan's claims review procedures. Any Employee, former Employee, or Beneficiary of either, who has been denied a benefit by a decision of the Plan Administrator pursuant to Section 9.17 shall be entitled to
Claims Review Procedures. All claims by the Participant for benefits under this Agreement shall be directed to and determined by the Board of Directors of PE and shall be in writing. Any denial by such board of a claim for benefits under this Agreement shall be delivered to the Participant in writing and shall set forth the specific reasons for the denial and the specific provisions of this Agreement relied upon. Such board shall afford a reasonable opportunity to the Participant for a review of the decision denying a claim and shall further allow the Participant to appeal to such board a decision of such board within sixty (60) days after notification by such board that the Participant's claim has been denied.
